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BACK IN ACTION PHYSICAL THERAPY AND FITNESS CENTER,LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
LYNNETTE K LATCHFORD DPT (OWNER)
(814) 684-0702
Entity
Organization

Contact information

Practice address
BUILDING II, ROUTE 220, TIPTON MEDICAL & DIAGNOSTIC CENTER, TIPTON, PA 16684
(814) 684-0702
(814) 684-0426
Mailing address
1407 EISENHOWER BLVD, SUITE 104, JOHNSTOWN, PA 15904-3262
(814) 684-0702
(814) 684-0426

Taxonomy

Speciality
Code
Description
License number
State
225100000X
Physical Therapist
Primary
PT015991L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
PT015991L
LICENSE NUMBER
PA
Enumeration date
02/19/2008
Last updated
03/19/2008
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